Josh Voorhees:
Chris Christie, Andrew Cuomo, and other American governors are the last people who should be making rules about Ebola.
TPM:
If anything is clear from the reporting of the nurse who was quarantined in a New Jersey hospital over Ebola fears, it's that the actual quarantine itself was handled miserably.
Nurse Kaci Hickox, who returned to the U.S. via Newark airport Friday after treating Ebola patients for Doctors Without Borders in Sierra Leone, described her treatment as "a frenzy of disorganization." She was so flustered that a forehead reading showed her with a fever -- which was then used as reason to quarantine her. Later, they took her temperature again and no fever registered. She was kept in quarantine anyway.
Further reported details of Hickox's predicament made clear that, although New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo were anxious to show resolve and order the quarantine, their local health officials weren't ready to carry out the order in any way that resembled humane treatment.
One of the best discussions I've seen was from an infectious disease expert on
The Cycle ~6 minutes in, Dr. Dan Diekema from The Society for Healthcare Epidemiology of America (
SHEA). Take a few minutes to watch the video.
Two more invaluable resources are a NEJM editorial (btw, blasting the NY/NJ Governors):
Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan's family members who were living in the same household for days as he was at the start of his illness did not become infected.
and a
Q&A from MSF/Doctors with Borders:
How contagious was [NYC/MSF Dr Spencer] when he was moving around the city?
Given when his symptoms began, and the extent of his fever when he first reported it—after which he was entirely isolated in his apartment—he would have been an extremely low risk for contagion. This is not an MSF assessment. This is based on all available medical and scientific knowledge about Ebola and how it spreads. Numerous public health and government officials have said as much and have lauded Dr. Spencer for quickly reporting the onset of his fever and for his conduct once the symptoms began.
People tooling around NYC on the subway are not contagious. Contagious people are too sick to travel and too sick to bowl. That's why no one from Dallas or the Cleveland airline exposures became ill. And that's the expected outcome in NYC.
More politics and policy below the fold.
Is the hysteria over Ebola new? Let's go back 100 years to a case of leprosy to see all too familiar parallels, this from René F. Najera, epidemiologist:
John Early was born in 1874 and served in the US Army from the age of 23 to 32. After his service, John married and moved to back to North Carolina. However, his work caused injuries to his skin, and he decided to quit and seek out a pension from the government based on his service. He traveled in August of 1908 to Washington, DC, alone to seek out that pension. Once there, Mr. Early had a severely swollen face and lesions on his skin. He went to see a doctor. What comes next, you’ll find very, very familiar:
“Remembering that Early had admitted to military service in the Philippines, the doctor, in fear of contagion, retired precipitously. He returned shortly with Dr. William C. Fowler, inspector for contagious diseases in the District of Columbia, who had never seen a true case of leprosy in his life. After a brief look, the two medical men went out, carefully locking the door behind them but soon returning with Dr. Joseph J. Kinyoun, pathologist at Washington University and founder of the U.S. Public Health Service Hygienic Laboratory. After a brief examination, Kinyoun remarked that the case was “strongly suspicious” and took a small cutting of Early’s facial skin to his laboratory. There he reported finding bacilli “corresponding morphologically with those of leprosy.” These findings were speedily endorsed by Dr. William C. Woodward, health officer of the District of Columbia and expert in medical jurisprudence, and Early was immediately removed from the locked room at the doctor’s office and forcibly quarantined in a hastily erected tent down on the marshy bottom adjacent to the eastern branch of the Potomac River.”
Read that one more time and tell me that we are not making the same mistakes more than 100 years later.
Incredible story and a must read.
Changing subjects, here's a hyperlocal story with a moral. In Newtown, CT we have a state representative with an odd 'both sides do it' approach to gun safety. His name is Dan Carter:
Heather Whaley, a Redding resident, sent a tweet to Mr. Carter including video of a League of Women Voter’s debate from the 2012 election. During the debate — which was before the Sandy Hook Elementary School shootings in Newtown and before the proposed gun legislation — each candidate was asked what their opinion is on gun safety and concealed carry permits.
Mr. Carter said he believed, at the time, the system in place was “pretty good” but it had some issues. He said he believes people should have to have a permit and that the state can use the FBI to conduct background checks.
“We should foster education as much as possible. Maybe work with the NRA (National Rifle Association) to bring program into schools. Do whatever it takes to make sure people know how to handle them safely,” said Mr. Carter in 2012. “I do not support any more restrictive laws than we have now.”
Ms. Whaley tweeted “At 1:06:35 listen to @DanCarterCT say we should bring the @NRA into schools. #terrbileidea #NAA #MomsDemand.”
Mr. Carter then responded, “@HeatherWhaley @NRA It was a bad idea. Just thought focus on safety would be good. I didn’t realize how badly the NRA would be vilified.”
Ms. Whaley then tweeted back, “@DanCarterCT @NRA they have done it to themselves. Like this nugget of brilliance advocating more guns for the blind.”
“@HeatherWhaley @NRA Yes they have. Both sides are against reasonable solutions, so they are all accountable for gun deaths- NRA, NAA, CAGV,” tweeted Mr. Carter.
That tweet then prompted many responses to Mr. Carter, including a press release issued by his opponent.
Carter voted no on the 2013 CT gun bill, while the three other Newtown Republicans voted yes.
Here's how Newtown Action Alliance (NAA) and Connecticut Against Gun Violence (CAGV), two local organizations forking for gun sense after the 12/14 shooting reacted to the Carter smear. We'll find out next week what difference it makes.
Good read from WaPo on the lay of the land:
The last two years have witnessed revelations about the surveillance state, Vladimir Putin's provocations, and the rise of the Islamic State. The IRS quasi-scandal and the revelations of worrisome gaps at the Secret Service have kept the press office at the White House busy. So has the catastrophic launch of the Obamacare Web site last year and the chaotic response to the Ebola epidemic this year.
Yet, despite what you might read in the news, Obama's unpopularity likely has little to do with these events. After Obama won reelection, his approval ratings were positive. They began declining early in 2013, before any of these crises developed. They continued to erode at a steady rate, regardless of the headlines from week to week, before leveling off at around 40 percent, according to the latest polling from The Washington Post-ABC News. Indeed, the ratings have hardly budged throughout the past 12 months, as Gallup's polling shows.
Frank Newport, editor-in-chief of Gallup, described this trend simply as "a regression to the mean," the gradual waning of the public's goodwill toward the president that he'd built up during his campaign for reelection and "the halo that comes with victory." This kind of decline is common for a president following a successful election campaign.
Jason Zengerle on why Martha Coakley is having a tough race.
Finally, Jeff Smith reads Andrew Cuomo's book so you don't have to. And finds that it sucks. See Quarantine This Book.
